AN ASSIGNMENT

ON

HYDROCEPHALY, ANENCEPHALY, MICROCEPHALY AND UMBILICAL HERNIA

BY

MEMBERS OF GROUP 6

SUBMITTED TO

DEPARTMENT OF NURSING SCIENCE

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

COLLEGE OF HEALTH SCIENCES

NNAMDI AZIKIWE UNIVERSITY

NNEWI CAMPUS

COURSE TITLE: ADVANCED MATERNAL AND CHILD HEALTH NURSING

COURSE CODE: NSC 522

LECTURER: DR. C. U. NWANKWO

1
 DECEMBER, 2021.

GROUP MEMBERS

1. NNOPU ONYINYE GIFT 2017634008

2. ALADINBULI MARYJANE 2017634012

3. ODENIGBO IFEOMA JACINTA 2017634013

4. NZEKWE JULIET ADAOBI 2017634018

5. IBEKWE LOUISA 2017634019

6. NWOKIKE CONSTANCE CHIZOBA 2017634026

7. ONYEKA CHIEMERIE EKPEREAMAKA 2017634029

8. OBASI CHIDIMMA FAITH 2017634032

9. IREKA CHIOMA RITA 2017634034

10. OHANEHI CHIDIMMA 2017634046

11. ILEKA OLUCHUKWU 2017634047

12. OGBUOWELU ADAOBI 2017634050

13. OKONKWO CHIAMAKA 2017634082

2
HYDROCEPHALY

Hydrocephalus is an abnormal buildup of fluid in the ventricles (cavities) deep within the brain.
This excess fluid causes the ventricles to widen, putting pressure on the brain’s tissues (NIH,
2021).

Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs

within the brain (NINDS, 2016).This typically causes increased pressure inside the skull.
(NINDS, 2016).

Incidence of Hydrocephaly

About one to two per 1,000 newborns have hydrocephalus (NINDS, 2016), (Stevenson & Benitz,
2003). Rates in the developing world may be higher (Ellenbogen, Abdulrauf & Sekhar, 2012).
Normal pressure hydrocephalus is estimated to affect about 5 per 100,000 people, with rates
increasing with age (Ferri, F. F, 2016).

Types of Hydrocephaly

The two major types of hydrocephalus are called communicating hydrocephalus and non-
communicating hydrocephalus. Hydrocephalus can be classified into communicating and non-
communicating (obstructive). Both forms can be either congenital or acquired.

Communicating hydrocephalus: This occurs when the flow of CSF is blocked after it exits the
ventricles. This form is called communicating because the CSF can still flow between the
ventricles, the passages between which remain open. Reduced flow and absorption of CSF into
specialized blood vessels called arachnoid villi can also result in a build-up of CSF in the
ventricles and communicating hydrocephalus. It is also called Non obstructive Hydrocephaly
(Kaye et al, 2014).

Non-communicating hydrocephalus: It occurs when the flow of CSF is blocked along one or
more of the narrow passages connecting the ventricles. It is also called obstructive hydrocephaly

3
Other additional types of hydrocephalus include:

Hydrocephalus ex-vacuo results from brain damage caused by stroke or injury. In these cases,
brain tissues around the ventricles shrink, and the ventricles are bigger than normal because of
this. Strictly speaking, this is not a true hydrocephalus, but rather, a “hydrocephalus look-alike”
condition.

Normal Pressure Hydrocephalus (NPH) can be the result of bleeding in the brain’s CSF
(subarachnoid or intraventricular hemorrhage), head trauma, infection, tumor, or a complication
of surgery. However, many people develop NPH when none of these factors are present. The
increase in cerebrospinal fluid in NPH occurs slowly enough that the tissues around the
ventricles compensate and the fluid pressure inside the head does not increase.

Congenital hydrocephalus: This is present at birth and may be the result of a brain defect
restricting the flow of cerebrospinal fluid (CSF).

Causes

The cause varies depending on the type:

The most common cause of congenital hydrocephalus is aqueductal stenosis, which occurs when
the narrow passage between the third and fourth ventricles in the brain is blocked or too narrow
to allow sufficient cerebral spinal fluid to drain. Fluid accumulates in the upper ventricles,
causing hydrocephalus. (THA, 2006). Hydrocephalus present at birth (congenital hydrocephalus)
can be caused by certain health conditions, such as spina bifida. It can also develop in babies
born prematurely, before week 37 of the pregnancy. Some people are born with narrowed
passageways in their brain that restrict the flow of cerebrospinal fluid, but do not cause any
symptoms until years later. Some premature babies have bleeding in the brain, which can block
the flow of CSF and cause hydrocephalus.

Other possible causes of congenital hydrocephalus include:

 A mutation of the X chromosome – this is known as X-linked hydrocephalus

 Rare genetic disorders – such as Dandy Walker malformation

4
  arachnoid cysts – fluid-filled sacs located between the brain or spinal cord and the
arachnoid membrane.

In many cases of congenital hydrocephalus the cause is unknown (NHS,2020)

Acquired Hydrocephaly: Hydrocephalus that develops in adults and children is often caused by
an illness or injury that affects the brain.

Possible causes of acquired hydrocephalus include: bleeding inside the brain – for example, if
blood leaks over the surface of the brain (subarachnoid haemorrhage), blood clots in the brain
(venous thrombosis), meningitis – an infection of the membranes surrounding the brain and
spinal cord, brain tumours, head injury, stroke

Normal Pressure Hydrocephaly: Hydrocephalus that develops in older people which may also
be the result of an infection, illness or injury, but in many cases it's not clear what causes the
condition. It may be that NPH is linked to other underlying health conditions that affect the
normal flow of blood – for example, diabetes, heart disease, or having a high level of cholesterol
in the blood (NHS, 2020).

Clinical Manifestation

Babies born with hydrocephalus (congenital hydrocephalus) often have distinctive physical
features. These can include:

 An unusually large head,

 A thin and shiny scalp with easily visible veins,
 A bulging or tense fontanelle (the soft spot on top of a baby's head),
 Downward looking eyes.

Acquired hydrocephalus:

The major symptom is headache which may be worse when you wake up in the morning. This is
because the fluid in your brain does not drain as well while you are lying down and may have
built up overnight.

Other symptoms of acquired hydrocephalus include:

5
  neck pain,
 feeling sick or being sick – this may be worse in the morning
 sleepiness – can progress to a coma
 changes in your mental state, such as confusion
 blurred vision or double vision
 difficulty walking
 an inability to control your bladder (urinary incontinence) and
 in some cases, your bowel (bowel incontinence) (NHS,2020).

Normal pressure hydrocephalus (NPH)

The symptoms of normal pressure hydrocephalus (NPH) tend to affect older people and usually
develop slowly, over many months or years.

NPH has 3 sets of distinctive symptoms. It affects:

 how you walk (mobility): Difficulty in walking

 the urinary system: They are experienced as bouts of urinary incontinence and include ;a
frequent need to pee, an urgent need to pee, loss of bladder control
 mental abilities: Thinking process is slowed down resulting in slow response to
questions, reacting slowly to situations, and slow in processing information (NHS,2020)

The symptoms could be early or late

 Early symptoms may also include:

 Eyes that appear to gaze downward
 Irritability
 Seizures
 Separated sutures
 Sleepiness
 Vomiting

6
Symptoms that may occur in older children can include:

 Brief, shrill, high-pitched cry

 Changes in personality, memory, or the ability to reason or think
 Changes in facial appearance and eye spacing (craniofacial disproportion)
 Crossed eyes or uncontrolled eye movements
 Difficulty feeding
 Excessive sleepiness
 Headaches
 Irritability, poor temper control
 Loss of bladder control (urinary incontinence)
 Loss of coordination and trouble walking
 Muscle spasticity (spasm)
 Slow growth (child 0–5 years)
 Delayed milestones
 Failure to thrive
 Slow or restricted movement
 Vomiting (Medlline plus, 2021).

Diagnosis

Diagnosis is typically made by physical examination and medical imaging. Congenital

hydrocephalus is sometimes found before a baby is born during an ultrasound scan. However, it's
usually diagnosed soon after birth during the newborn physical examination. The condition may
be suspected if your baby's head is larger than normal.

Tests to accurately diagnose hydrocephalus and rule out other conditions may include:

 Ultrasound

 Magnetic resonance imaging (MRI)

7
  Computed tomography (CT)

 Spinal tap (lumbar puncture)

 Intracranial pressure monitoring (ICP)

 Fundoscopic examination

Treatment

Hydrocephalus (excess fluid in the brain) is treated with surgery. Both congenital and acquired
hydrocephalus are treated with either shunt surgery or neuroendoscopy.

Shunt surgery: During shunt surgery, a thin tube called a shunt is implanted in your brain. The
excess cerebrospinal fluid (CSF) in the brain flows through the shunt to another part of your
body, usually your tummy. From here, it's absorbed into your blood.

Endoscopic third ventriculostomy (ETV): An alternative procedure to shunt surgery is an

endoscopic third ventriculostomy (ETV). Instead of inserting a shunt, the surgeon makes a hole
in the floor of your brain to allow the trapped cerebrospinal fluid (CSF) to escape to the brain's
surface, where it can be absorbed. ETV is not suitable for everyone, but it could be an option if
the build-up of CSF in your brain is caused by a blockage (obstructive hydrocephalus). The CSF
will be able to drain through the hole, avoiding the blockage.

Other treatments

Many people diagnosed with hydrocephalus benefit from rehabilitation therapies and educational
interventions. Treatment by an interdisciplinary team of medical professionals, rehabilitation
specialists, and educational experts is critical to a positive outcome.

Supportive therapies for children may include:

 Occupational and developmental therapists who can help children learn life skills and
develop social behaviours.

 Special education teachers who can help tackle learning disabilities

8
  Mental health providers or social workers who can provide emotional support and help
families find services.

 Adults may also require similar support, including social workers, occupational
therapists, and specialists in dementia care.

Prognosis

If left untreated, hydrocephalus can be fatal by causing an increase in pressure which will cause
brain damage. Early diagnosis and successful treatment improve the chance for a good recovery.

With the benefits of surgery, rehabilitative therapies, and educational interventions, many people
with hydrocephalus live relatively normal lives. The symptoms of NPH usually get worse over
time if the condition is not treated, although some people may experience temporary
improvements.

While the success of treatment with shunts varies from person to person, some people recover
almost completely after treatment and have a good quality of life.

Complications

The surgery used to treat hydrocephalus (excess fluid in the brain) can cause complications.

 Shunt Surgery

 Shunt problems i.e malfunction

 Shunt blockage

 Shunt infection

 Endoscopic third ventriculostomy (ETV)

The hole can close your brain may not be able to absorb the CSF that is now draining through it
you may develop an infection – although this is less likely than after shunt surgery. You may

9
have bleeding inside your brain – this is usually minor. If there is a problem with the hole, it may
be possible to repeat the procedure, or you may need to have a shunt fitted.

Other risks of ETV include nerve problems, such as weakness down 1 side of the body, double
vision or hormone imbalances. Most nerve problems will get better, but there's a small risk of
permanent problems.

There's also a small risk of epilepsy, and a very small risk of an injury to a blood vessel in the
brain, which may be fatal.

10
ANENCEPHALY

Anencephaly is a serious birth defect in which a baby is born without parts of the brain and skull.
It is a type of neural tube defect (NTD). As the neural tube forms and closes, it helps form the
baby’s brain and skull (upper part of the neural tube), spinal cord, and back bones (lower part of
the neural tube) (CDC,2021).

Anencephaly is a birth defect in which the brain and bones of the skull don’t form completely
while the baby is in the womb. As a result, the baby’s brain, particularly the cerebral cortex,
develops minimally. The cerebral cortex is the part of the brain primarily responsible for
thinking, movement, and senses, including touch

Incidence

Researchers estimate that about 1 in every 4,600 babies is born with anencephaly in the Universe

Causes

Anencephaly is a serious developmental defect of the central nervous system in which the brain
and craninial vault are grossly malformed. The cerebrum and cerebellum are reduced or absent,
but the hindbrain is present. Anencephaly is a part of the neural tube defect (NTD) spectrum.
This defect results when the neural tube fails to close during the third to fourth weeks of
development, leading to fetal loss, stillbirth, or neonatal death. (Healthline, 2020).

The cause of anencephaly is generally unknown, which can be frustrating. For some babies, the
cause may be related to gene or chromosome changes. In most cases, the baby’s parents have no
family history of anencephaly.

A mother’s exposure to certain environmental toxins, medications, or even foods or beverages

may play a role. However, researchers don’t know enough about these potential risk factors yet
to provide any guidelines or warnings.

11
Exposure to high temperatures, whether from a sauna or hot tub or from a high fever, may raise
the risk of neural tube defects.

The Cleveland Clinic suggests certain prescription drugs, including some of those used to treat
diabetes, may increase the risk for anencephaly. Diabetes and obesity may be risk factors for
pregnancy complications, so it’s always ideal to talk with your doctor about any chronic
conditions and how they may affect your pregnancy.

One important risk factor related to anencephaly is inadequate intake of folic acid. A lack of this
key nutrient may raise your risk of having a baby with other neural tube defects in addition to
anencephaly, such as spina bifida. Pregnant women can minimize this risk with folic acid
supplements or diet change so as to have a healthy baby.

Diagnosis

Anencephaly can be diagnosed during pregnancy or after the baby is born.

During Pregnancy

During pregnancy, there are screening tests (prenatal tests) to check for birth defects and other
conditions. Anencephaly would result in an abnormal result on a blood or serum screening test or
it might be seen during an ultrasound (which creates pictures of the body). For more information
about screening and confirmatory tests during pregnancy, visit CDC’s birth defects diagnosis
web page.

After the Baby is born

In some cases, anencephaly might not be diagnosed until after the baby is born. Anencephaly is
immediately seen at birth (CDC, 2020).

Treatments

There is no known cure or standard treatment for anencephaly. Almost all babies born with
anencephaly will die shortly after birth.

12
MICROCEPHALY

Microcephaly is a medical condition in which the circumference of the head is smaller than
normal because the brain has not developed properly or has stopped growing. Microcephaly can
be present at birth (congenital) or it may develop in the first few years of life (Charles, 2021).

Babies born with microcephaly will have a smaller than normal head that will fail to grow as
they progress through infancy (Charles, 2021).

Types

Two different types of microcephaly are recognized: primary and secondary (Britannica, 2021).

Primary microcephaly occurs when the brain does not grow to the normal size in utero.
Irradiation of the abdomen in pregnant women or maternal infection with cytomegalovirus,
rubella (German measles), toxoplasmosis, varicella (chickenpox), or Zika virus during the first
three months of pregnancy may sometimes result in primary microcephaly in the infant.
Evidence suggests that maternal alcohol consumption during pregnancy and poor nutrition may
also contribute to primary microcephaly. Genetic factors also play a role.

Secondary microcephaly occurs when the brain, roughly normal in size at birth, does not grow
thereafter. Brain infection, traumatic brain injury, and oxygen deprivation in the brain are causes
of postnatal onset. It also can occur in association with certain metabolic disorders or genetic
syndromes, such as Rett syndrome.

Causes

Most often it is caused by genetic abnormalities that interfere with the growth of the cerebral
cortex during the early months of fetal development.

 It is associated with Down's syndrome, chromosomal syndromes, and neurometabolic

syndromes.

13
  Drugs or alcohol abuse during pregnancy,

 Infection with cytomegalovirus, rubella (German measles), or varicella (chicken pox)

virus

 Exposure to certain toxic chemicals, or an untreated phenylketonuria (PKU)

Signs and symptoms

Depending on the severity of the accompanying syndrome, children with microcephaly may
have:

 Impaired cognitive development

 Delayed motor functions and speech

 Facial distortions

 Dwarfism or short stature

 Hyperactivity

 Seizures

 Difficulties with coordination and balance, and other brain or neurological abnormalities.

 Some children with microcephaly will have normal intelligence and a head that will grow
bigger, but they will track below the normal growth curves for head circumference
(Charles, 2021).

Medical management

There is no standard treatment for microcephaly.

Sometimes medications are needed to treat seizures or other symptoms.

A team of persons of different discipline may help in assessment and care of babies and children
with mimicrocephaly.

14
Nursing management

 Take history

 Physical examination

 Frequent examinations and testing to monitor the development of the head as the child
grows.

 Supportive measures like occupational, physical and speech therapy are often employed
to assist with development.

 Treating the child’s ongoing health problems.

 Maximizing his or her capabilities at home and in the community. This might include
speech, occupational and physical therapies.

 Family counseling and psychological support for parents should be integral part of the
case management.

Complications

 Depending on the cause and severity, complications may include:

 Developmental delays, such as in speech and movement

 Difficulties with coordination and balance

 Dwarfism or short stature

 Facial distortions

 Hyperactivity

 Intellectual disabilities

 Seizures

15
  Prevention

 Some children with microcephaly are of normal intelligence and development, even
though their heads will always be small for their age and sex.

UMBILICAL HERNIA

Umbilical hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button).
This hernia develops when a portion of the lining of the abdomen, part of the intestine, and/or
fluid from the abdomen, comes through the muscle of the abdominal wall (Saurabh, 2018).

Umbilical hernias are common, occurring in 10 percent to 20 percent of all children. They are,
however, more common in African-Americans. Low birth weight and premature infants are also
more likely to have an umbilical hernia. Boys and girls are equally affected (Saurabh, 2018).

Causes of Umbilical Hernia

As the fetus develops during pregnancy, there is a small opening in the abdominal muscles that
allows the umbilical cord to pass through, connecting mother to baby.

As the baby grows after birth, this opening in the abdominal muscles closes. Sometimes,
however, these muscles do not meet and grow together completely, and a small opening remains.
This opening is called an umbilical hernia.

Risk factors

Major risk factors for umbilical hernias are:

Age: Infants, especially those born preterm, have a higher risk of an umbilical hernia than adults.

Obesity: Children and adults with obesity face a significantly higher risk of developing an
umbilical hernia, compared with individuals of normal weight for their height and age.

Coughing: Having a cough for a long period of time can increase the risk of hernias, because the
force of coughing applies pressure to the abdominal wall.

16
Multiple pregnancies: When a woman is carrying more than one baby as part of a pregnancy, the
risk of an umbilical hernia is higher.

Signs and Symptoms of Umbilical Hernia

Umbilical hernias appear as a bulge or swelling in the belly button area. The swelling may
become more noticeable when the baby cries, and may become smaller or disappear when the
baby is quiet.

If a physician gently pushes on the bulge when a child is lying down and calm, it will usually get
smaller or go back into the abdomen.

Sometimes the intestines get trapped within the umbilical hernia. This is referred to as an
incarcerated hernia. When this occurs, the child usually has severe pain and the bulge may be
firm and red. Urgent medical evaluation to exclude an incarcerated hernia is required in order to
prevent possible damage to the intestines. It is uncommon for this to occur.

Diagnosis

Physical examination by a physician can diagnose an umbilical hernia and can also determine if
there are any abdominal contents caught in the hernia sac. Physician may also request an
abdominal ultrasound, X-ray, or blood tests.

Medical management.

Treatment is not always required, as some instances of umbilical hernia self-resolve. However,
this may not always be the case.

Infants and children: For the majority of infants, the hernia closes without treatment by the age
of 12 months. Sometimes, the doctor may be able to push the lump back into the abdomen.

Surgery may be requested if:

 The hernia grows after the child is 1 to 2 years old

17
  The bulge is still present by the age of 4 years

 The intestines are within the hernial sac, preventing or reducing intestinal movement a
hernia becomes trapped.

Nursing management

Admission in clean pediatric ward

History taking and physical examination

Pain assessment – The most critical nursing intervention would be to assess the patient’s pain
using verbal description or non-verbal signs such as crying in children, facial changes or
restlessness. The correct identification of the pain can lead to proper intervention by means to
reduce the pain.

Medicine Administration – Once the patient’s pain is identified, a trained nurse can administer
the pain alleviation medication as outlined in the patient’s nursing care plan.

Help in Positioning

Support Parents in Infant Care – Seeing their little one suffer is a difficult time for parents, and
they need all the support to help the child through these painful times. The nurse’s training
includes a nursing care plan for umbilical hernia, and hence they can support the parents suitably
in taking care of the child.

Diet Help – It is the nursing staff that helps the patient get back with their diet after the
operation.

Training the Parents – While the child is in pain, they may not eat properly. At this time, the
nurse can train the parents on how to hold the child so as to minimize the pain, how to feed or
change the diapers. All this is part of any nursing care plan for hernia.

Complications

Complications of umbilical hernia are rare in children.

18
If the protrusion becomes trapped and cannot be pushed back into the abdominal cavity, the
primary concern is that the intestines might lose blood supply and become damaged.

If the blood supply is completely cut off, there is a risk of gangrene and life-threatening
infections. Incarceration is rare in adults and even less common in children.

REFERENCES

Britannica. (2021). Microcephaly medical condition. Retrieved from

https://www.britannica.com/science/microcephaly

Charles, P. (2021). Microcephaly facts. Retrieved from

https://www.medicinenet.com/microcephaly/article.htm

Ellenbogen, R.G., Abdulrauf, S.I., Sekhar L.N., (2012). Principles of Neurological Surgery.
Elsevier Health Sciences. p. 105. ISBN 978-1-4377-0701-4.

Ferri F.F., (2016). Ferri's Clinical Advisor 2017: 5 Books in 1. Elsevier Health Sciences. p. 621.
ISBN 9780323448383. Archived from the original on 2016-12-21.

Hemanshu P (2016-02-29). Complications in neuroanesthesia. ISBN 9780128040751. OCLC

939553425

"Hydrocephalus Fact Sheet". NINDS., (2016). Archived from the original on 27 July 2016.
Retrieved 5 September 2016.

Kahle K.T., Kulkarni A.V., Limbrick D. D., Warf B. C., (2016). "Hydrocephalus in children".
The Lancet. 387 (10020): 788–99. doi:10.1016/s0140-6736(15)60694-8. PMID
26256071. S2CID 27947722.

Kaneshiro N. K., Zieve D, Black B, A.D.A.M. Editorial team. "Hydrocephalus". MedlinePlus.

"The Hydrocephalus Association". Archived from the original on 2006-08-20.

Kaye, Alan; Fox, Charles; Diaz, James (2014). Essentials of Pediatric Anesthesiology.
Cambridge University Press. p. 106.

19
Saurabh, S. (2018). Umbilical hernia: What you need to know. Retrieved from
https://www.medicalnewstoday.com/articles/189580#risk-factors

Stevenson D.K., Benitz WE (2003). Fetal and Neonatal Brain Injury: Mechanisms, Management
and the Risks of Practice. Cambridge: Cambridge University Press. p. 117. ISBN
9780521806916. Archived from the original on 2016-12-21.

20